Results of Emergency Coronary Artery Bypass Grafting for Acute Myocardial Infarction: Importance of Intraoperative and Postoperative Cardiac Medical Therapy

Abstract

Background: The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common. Methods and Results: 105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml. Conclusions: Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.

Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

“…In a study examining immediate surgical coronary revascularization for acute MI, Khaladj and associates 5 showed a 30-day mortality rate of 6%, slightly lower than ours. In a similar study, Sezai and co-authors 12 reported an 11.4% mortality rate for patients after emergency CABG for acute MI. The lower mortality rate in the Khaladj and colleagues 5 report (lower than the rate reported in this current study) is most likely the result of our including indications for emergency CABG in our study, which gives us an acutely sicker patient cohort.…”

“…However, the overall rate of PCI has declined over the last decade, because PCI now tends to be reserved for patients with more complex conditions. 2 Whereas mortality rates after emergency CABG from all causes are reported to be between 7% and 12%, 5,6,11,12 mortality rates in emergency CABG after attempted PCI are as high as 14%. 17 These data are crucial in eventually improving outcomes for these patients.…”

The Role of β-Blockers in Cardiac Perioperative Management

“…It seems that β-blocker prophylaxis may be required during cardiac surgery, while adequate multimodal therapy including RAS inhibitors and diuretics may lead to improvement of both short-term and long-term results. 26,27) …”

Early and Long-Term Outcomes in Japanese Patients Aged 80 Years or Older Undergoing Conventional Aortic Valve Replacement

“…In addition, appropriate perioperative medical therapy should be provided to reduce postoperative complications related to cardiopulmonary bypass and other complications such as cerebral infarction and renal failure. [15][16][17] …”